A modest proposal regarding the orphan child of academic surgery--teaching.
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The present work deals with the issue of child's adoption. Adoption is presented as a difficult (stressful) situation for the adopted child, but also for the childless married couple, who has decided to take in the orphaned child. Adoption as a difficult situation is connected with the experience of loss. The childless spouses experience the loss of their biological parenthood, the loss of their biological child, who died during the prenatal period or just after being born, but also the loss of the status of a "normal" family created in accordance with the normative model of a family. The adopted child, on the other hand, experiences the loss of biological parents and biological siblings, the loss of genealogical continuity and of "the bonds of blood". The child must be confronted with the fact that "one, to be adopted, must be first abandoned". The problem with the studies on adoption lies in their theoretical character. Because of that, the psychological understanding of adoption reality is limited.
This study examines social workers' perceptions of the needs of families coping with acquired immunodeficiency syndrome (AIDS). This research investigates the problems of family caregivers of children orphaned by human immunodeficiency virus (HIV)-related death of their parents. A qualitative semistructured interview format was used in a focus group of 18 social workers. Four questions were designed to assess family needs and resources, as well as to evaluate the social workers' perspectives of governmental policies affecting these families. A list of four problems and two recommendations for change evolved from the focus group. Inadequate finances to house and care for the children was the primary cause for distress in these families. The major governmental policy that hindered the social workers' ability to assist families pertained to the low financial entitlement for caregivers who are related to the orphaned child. It was noted that unrelated caregivers receive substantially more money for the care of these children than family caregivers receive. Recommendations were made to change this policy and to develop guardianship laws that facilitate families' abilities to provide care to AIDS orphans. Family caregivers of AIDS orphans are bombarded with great demands and limited resources. This analysis of their situation from the social workers' perspective is a positive step toward the improvement of support services for these families. Further research should include individual qualitative interviews assessing the needs of the caregivers and AIDS orphans.
With rising numbers of single-parent families, a phenomenon becoming increasingly prevalent is the child orphaned by cancer. We sought to examine issues related to custody planning addressed prior to the patient's death. Ten deceased patients with minor children were identified. The contact person was administered a brief questionnaire regarding the minor children and custody issues. The study involved twenty children, ages ranging from 3-20, mean age 9.8. Only five of the ten families developed custody plans that were ultimately successful. One-half of the families reported the patient had suffered with this issue and almost one-half of the children were not aware of the custody plans that had been arranged for them. In 40% of the cases, the children ultimately went to people to whom the deceased parents were opposed. It is our belief that if we can improve these statistics, we might improve the quality of life of these families.
Profound loss in childhood as a precipitant for symptoms of posttraumatic stress disorder has been a largely neglected subject. There is now some literature to suggest that severe loss and the absence of care may be as predictive of psychological distress in children as events that are more frequently studied, such as exposure to natural disasters and physical or sexual abuse. This paper combines the author's personal experience as an orphaned child who was placed in foster care with a discussion of this emerging literature to examine the relationship between childhood loss and trauma symptoms. An awareness of the traumatic nature of severe losses in childhood could help caregivers and mental health professionals deal more effectively with such children.
This paper challenges the limited models of childhood, conflict and relief which determine most humanitarian interventions targeting children in conflict related emergencies. In particular, it notes the tendency of relief programmes to focus on "spectacular" groups of children (orphans, child combatants and refugees) at the expense of larger child populations indirectly affected by conflict. This relief bias is attributed to an inappropriate 'apocalypse model' of conflict which sees relief interventions only as repair. The bias also lies in a mistakenly universalist model of childhood and a medical paradigm which pathologizes children's experience in conflict and characterizes children as passive victims rather than active survivors. The paper argues for greater recognition of the wider social experience of children in conflict, and for relief practice which takes account of childhood resilience and children's different roles and capacities in coping with conflict. Appropriate interventions must engage with the wide variety of indigenous coping mechanisms involving children and not simply replicate a standard package of relief interventions in every emergency, based on simplistic and universalist interpretations of children's experience of conflict.
A clinical isolate, Escherichia coli MG-1, isolated from a 4-month-old Vietnamese orphan child, produced a beta-lactamase conferring resistance to extended-spectrum cephalosporins and aztreonam. In a disk diffusion test, a typical synergistic effect between ceftazidime or aztreonam and clavulanic acid was observed along with an unusual synergy between cefoxitin and cefuroxime. The gene for VEB-1 (Vietnamese extended-spectrum beta-lactamase) was cloned and expressed in E. coli JM109. The recombinant plasmid pRLT1 produced a beta-lactamase with a pI of 5.35 and conferred high-level resistance to extended-spectrum (or oxyimino) cephalosporins and to aztreonam. Vmax values for extended-spectrum cephalosporins were uncommonly high, while the affinity of the enzyme for ceftazidime and aztreonam was relatively low. blaVEB-1 showed significant homology at the DNA level with only blaPER-1 and blaPER-2. Analysis of the deduced protein sequence showed that VEB-1 is a class A penicillinase having very low levels of homology with any other known beta-lactamases. The highest percentage of amino acid identity was 38% with PER-1 or PER-2, two uncommon class A extended-spectrum enzymes. Exploration of the genetic environment of blaVEB-1 revealed the presence of gene cassette features, i.e., (i) a 59-base element associated with blaVEB-1; (ii) a second 59-base element just upstream of blaVEB-1, likely belonging to the aacA1-orfG gene cassette; (iii) two core sites (GTTRRRY) on both sides of blaVEB-1; and (iv) a second antibiotic resistance gene 3' of blaVEB-1, aadB. blaVEB-1 may therefore be the first class A extended-spectrum beta-lactamase that is part of a gene cassette, which itself is likely to be located on a class 1 integron, as sulfamide resistance may indicate. Furthermore, blaVEB-1 is encoded on a large (> 100-kb) transferable plasmid found in a Klebsiella pneumoniae MG-2 isolated at the same time from the same patient, indicating a horizontal gene transfer.
Growing numbers of women and men who are HIV infected and aware of their serostatus, want to have children. Gynecologists are involved in the dilemmas of counseling those couples about reproductive decisions. For HIV infected women, pregnancy is contra-indicated, mostly because of the risk of transmission to the fetus/infant. However, no rational argument can abolish the desire of many young women to have children in the face of the life-threatening infection. The clinical and immune status of the would-be mothers, her partner's serostatus and the availability of family members to rear an orphaned child, must be considered. For seronegative women with HIV-infected partners, after confirming that seroconversion is not occurring, the partner's clinical and immune status must be evaluated. The risk of transmission through unprotected intercourse increases with the degree of immune suppression in the partner. The couple's stability and the woman's motivations for becoming pregnant must also be carefully evaluated. About one third of such discordant couples separate after the birth of their child. For selected couples who have clearly decided to attempt pregnancy, the objective of reproductive counseling is to reduce their risk of heterosexual transmission. The partner's sperm should not be used for insemination because techniques have not yet been established to eliminate HIV from sperm preparations. Insemination with HIV-negative donors' sperm can be considered. An alternative is the "natural" method, consisting in having unprotected intercourse only during ovulation. Administration of zidovudine to the man in order to reduce the amount of virus excreted has been discussed.(ABSTRACT TRUNCATED AT 250 WORDS)
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